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Alzheimer's disease is best known for causing loss of memory and intellectual ability, but it also can include a number of behavioral and psychological symptoms. For that reason, doctors are placing an ever-greater emphasis on psychological therapy as a key part of a person's early Alzheimer's treatment.

Unlike the cognitive decline caused by Alzheimer's, which is both chronic and progressive, the psychological problems that spring from the disease tend to fluctuate, coming and going depending on the person's mental and emotional state.

"Some experts would put psychotherapy on the same par as medication treatment," says Christopher Callahan, MD, the Cornelius and Yvonne Pettinga Professor in Aging Research for the Indiana University School of Medicine, and director of the Indiana University Center for Aging Research, in Indianapolis, IN. "Others would say there's evidence it's even more effective in early stages."

Psychotherapy following initial diagnosis can help a patient deal with the depression, agitation, and anxiety caused by the disorder, as well as behavioral problems like delusions that can accompany Alzheimer's. Talking to a therapist can also be helpful as someone struggles to come to terms with, and accept, their (or their loved one's) new diagnosis. As Alzheimer's progresses, however, psychotherapy becomes less useful to the patient as cognitive decline occurs and the ability to express feelings is lost. Caregivers can continue to benefit from working with a mental health professional, though.

Depression and Alzheimer's Treatment

Depression occurs in up to 40 percent of Alzheimer's patients, making it one of the most common psychological problems to accompany the disorder.

"It can be difficult when Alzheimer's patients are depressed and not treated properly because it will compound their cognitive difficulties and prevent them from receiving optimal care," says Allen Levey, MD, chair of neurology at Emory University School of Medicine and director of the Emory Center for Neurodegenerative Disease and Alzheimer’s Disease Center. "For example, depression often leads to apathy and less interest in doing things like physical exercise or mentally stimulating activities that are believed to improve the condition of Alzheimer's patients."

Antidepressant medication is one way to tackle depressive symptoms, but therapy also can play a part.

Mental-Health Specialists for Alzheimer’s Treatment

Enlisting a team of specialists to help you deal with your loved one’s psychological problems caused by Alzheimer’s disease is a smart thing to do. Such specialists might include:

Psychotherapists. Psychotherapy can help newly diagnosed patients deal with feelings of anxiety or anger caused by their Alzheimer's. The therapist can help a person understand these feelings and can prescribe medication when needed. For patients in later stages, you might ask the therapist about "emotion-oriented psychotherapy," which focuses on happy thoughts and memories. It’s been shown to help draw Alzheimer's patients out of depression, which helps improve their overall outlook and affects their care. A therapist also can involve an Alzheimer’s patient in stimulating activities like art or dance. ·

Social workers. These specialists are trained to help Alzheimer's patients and caregivers and also will have training to help deal with your specific circumstances, particularly problems you encounter at home, with your family, or in your community. ·

Geriatric psychiatrists. You might want to find a geriatric psychiatrist who specializes in the mental health of senior citizens. These experts often are trained to help people with declining cognitive ability, including Alzheimer's disease.

Psychological Therapy for Caregivers

Many psychiatrists who work with people who have Alzheimer's also include the caregiver in the therapy, both to assess the caregiver’s level of burnout and to develop plans to engage the person in therapeutic activities for Alzheimer's patients. "It's therapy for the patient and it's education for the caregiver on how they can respond to problems," Dr. Callahan says.

The psychiatrist can show a caregiver how to recognize problems and address them. For example, something in the home might be causing the patient's agitation or depression. Overstimulation in the evening might be leading to agitation; a sense of insecurity could be causing anxiety. Recognizing these situations as potential issues and correcting them will save your loved one, and yourself, a good deal of stress.

The bottom line: If you're caring for someone with Alzheimer's disease, it's worth talking to your doctor about how to receive psychological care for you and/or your loved one. It can play a key part in the treatment process, both for you and the patient alike.

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